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Published on: August 2, 2024
Aspiration of parafalcine empyemas with flexible scope
Francesco Sammartino1, Alberto Feletti2, Alessandro Fiorindi1
1Department of Neurosurgery, Treviso Regional Hospital, University of Padova, Treviso, Italy.
Purpose:
Subdural empyemas are considered neurosurgical emergencies, and the parafalcine location is particularly insidious. We revised the experience of general surgeons who are used to manage chronic pleural purulent collections with video-assisted thoracoscopy.
Methods:
With a similar technique, we successfully aspirated a parafalcine empyema using a flexible scope avoiding a more invasive craniotomy. A review of the treatment options of empyematous collections is also provided, focusing particularly on the hazardous parafalcine location.
Results:
The management of subdural empyemas poses different decision-making problems compared to common brain abscesses, urging a more rapid and holistic surgical treatment with minimally invasive approach. Endoscopic aspiration of parafalcine empyema was followed by complete recovery in our patient.
Conclusions:
Flexible endoscopy is a promising method to obtain complete pus removal even from loculated collections through a bur hole, avoiding large craniotomies and consequent potential complications.
Insights
Flexible endoscopy offers a minimally invasive solution for subdural empyemas, particularly in challenging parafalcine locations. This approach successfully removed pus through a bur hole, leading to complete recovery and avoiding extensive craniotomy.
Area of Science:
- Neurosurgery
- Minimally Invasive Surgery
- Endoscopy
Background:
- Subdural empyemas (SEs) are neurosurgical emergencies.
- Parafalcine location of SEs presents unique management challenges.
- Traditional craniotomy for SEs carries significant risks.
Observation:
- Video-assisted thoracoscopy techniques were adapted for SE management.
- Flexible endoscopy was utilized via a bur hole to aspirate a parafalcine empyema.
- This approach avoided the need for a more invasive craniotomy.
Findings:
- Endoscopic aspiration achieved complete pus removal from the loculated collection.
- The patient experienced a full recovery following the procedure.
- This minimally invasive technique proved effective for parafalcine empyema.
Implications:
- Flexible endoscopy is a promising alternative for treating SEs, especially in difficult locations.
- This method reduces the potential complications associated with large craniotomies.
- It enables rapid and holistic surgical treatment for empyematous collections.
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